Bronchopulmonary Dysplasia (BPD) (Nursing)

00:01 Hello, welcome to the lecture on bronchopulmonary dysplasia.

00:04 This is one of the top respiratory problems that premature infants live with.

00:09 Thanks to advances in technology today.

00:11 There's more premature infants being born every day and surviving.

00:14 They live with this condition the rest of their lives.

00:18 We're gonna start by going over what bronchopulmonary dysplasia actually means, and then the major causes of it, as well as the manifestations, prevention measures, and treatment of the signs and symptoms.

00:32 Let's start by going over the definition.

00:35 All right, let's start with a quick review of terms.

00:38 The word bronchopulmonary means related to the bronchus, or the bronchi, and the lungs.

00:46 Dysplasia means abnormal cell growth or damage cells.

00:50 When there's abnormal cell growth or damage cells in the lung, such as the ones in the right lower picture with the damage or unhealthy alveoli.

01:00 There's impaired gas exchange and oxygen can't make it to the body as well as it should.

01:08 Bronchopulmonary Dysplasia basically means abnormal cell growth or damaged tissue in the lungs.

01:16 Infants are not born with this.

01:18 It actually results from damage that occurs after birth, as a result of things that are meant to help the patient breathe.

01:27 In immature lungs, when there's damage to the lung tissue, the inflammation can cause a cycle of chronic abnormal cell growth and repeated inflammation after that cell growth.

01:37 Both of these things result in a more impaired gas exchange.

01:41 Premature infants who require oxygen therapy for more than 28 days are considered to have BPD.

01:48 The more premature the newborn, the more immature the lungs, and the greater the risk of developing BPD because they're more at risk for needing things like mechanical ventilation that can cause it.

01:59 It's actually a clinical diagnosis.

02:01 There's no diagnostic test for it.

02:03 The symptoms of respiratory distress, radiographic findings, and the time and length of their need for oxygen or other support all help determine the diagnosis of BPD.

02:16 According to the 2019 National Institute of Child Health andHuman Development’s revised definition of BPD, If a preterm infant needs Nasal cannula flow of <2 L/min at 36 weeks gestational age, they are considered to have mild BPD.

02:33 Preterm infants who have moderate BPD require Nasal cannula flow of >2 L/min or non-invasive positive pressure ventilation such as nasal CPAP at 36 weeks PMA.

02:47 Severe, is a need for Invasive PPV at 36 weeks PMA.

02:54 Invasive PPV refers to PPV through an endotracheal tube or a tracheostomy tube.

03:03 Okay, let's dive a little deeper into how BPD occurs.

03:10 BPD is actually considered a complication of prematurity.

03:13 Because it's something that premature infants deal with, it's not something they're born with.

03:18 It's most common and very small, premature infants who require some sortof assistance with their breathing.

03:23 The reason is, assistance typically means they need pressure to deliver that assistance.

03:29 And pressure can be damaging to fragile immature lung tissue.

03:35 Mechanical ventilation and oxygen therapy are both treatments that while they help the patient, they can also cause damage to very fragile or immature lung tissue.

03:45 Remember that infants are not born with BPD.

03:48 They develop it after birth as a result of treatments that they require.

03:54 All right, let's take a look at the premature lung.

03:58 This picture at the top is overstretched alveoli.

04:01 This is what happens when alveoli are subject to a little too much pressure in an effort to inflate them and help with gas exchange.

04:09 The bronchioles lead to the alveoli, which are the little balloon light sacs where gas exchange occur.

04:15 When there's high amounts of oxygen and pressure that are pushed into them, it can cause the alveoli to become overstretched or even to collapse.

04:23 It can also cause the bronchioles which are the little branches that lead to the alveoli, to get irritated and inflamed.

04:31 When the alveoli become overstretched or collapse, they don't work as well.

04:35 The same thing happens when the bronchioles become irritated and inflamed as a result of both or either gas exchange can occur as well as it should.

04:45 These effects are especially damaging to premature lungs that are still developing, which is why the more premature the infant is at birth, that usually the more severe the damage is to their lungs as a result of the treatments meant to help them.

04:59 Infants before their lungs are fully developed to require administration of a special liquid called surfactant, which actually normally occurs in normal full term lungs.

05:10 It's something that's usually present naturally, but if it's not present, the lungs can't function properly.

05:17 The surfactant deficiency is actually the major cause of RDS or Respiratory Distress Syndrome in preterm neonates.

05:24 Is closely linked to BPD, but not all infants with RDS will develop BPD.

05:30 All right, let's review some specific examples of some of the causes of BPD.

05:35 Sometimes BPD can happen if another problem that affects the lungs in some way occurs, such as, certain birth defects, certain heart problems, or defects, pneumonia, or some prenatal or postnatal infections.

05:50 All these things can cause stress, a lot of extra work and sometimes damage or injury to the lungs which can contribute to BPD, especially in a preterm or premature infant.

06:04 All right, now let's review how an infant with BPD may present.

06:08 Some of the signs and symptoms that may occur in an infant with BPD are similar to the signs and symptoms of any infant and respiratory distress.

06:17 They may be very similar to other forms of respiratory distress.

06:20 They can include hypoxia, or an inability to wean from oxygen, breathing problems that may range from increased work of breathing through retractions, like the sucking in of the skin, under the sternum, in between the ribs, above the clavicles.

06:35 They may have nasal flaring, which is another sign of air hunger and labored breathing.

06:41 They may have wheezing, abnormal breath sounds.

06:43 You may not hear good breath sounds at all.

06:46 So, it really run the gamut.

06:48 But you should be able to tell, if you uncover the child when you assess them, when you have actually put your stethoscope on them, you should be able to tell they're in respiratory distress.

06:59 They may also have difficulty feeding, and that is largely because they can't breathe, especially when they're feeding.

07:06 Repeated lung infections may require hospitalization, because these infants typically are very vulnerable to other infections and other insults to their lungs.

07:17 All right, now that we know BPD has no cure.

07:20 Let's talk about what we can do to help prevent it and into the respiratory distress and immature lungs.

07:27 Pretend like this is a premature infant who's hypoxic, who's requiring oxygen and his respiratory distress, and is suspected to have BPD.

07:35 What might be done? So, surfactant given in the first two hours of birth.

07:40 If the child doesn't have it already in their lungs, coats the alveoli and helps them work correctly.

07:45 It can also help prevent them from collapsing.

07:49 Another way to help prevent BPD, is to use the lowest level of pressure and oxygen required to support them.

07:57 Using high frequency oscillatory ventilation for intubated infants also helps prevent BPD.

08:03 Because the gentler method of delivering these ventilations.

08:07 And lastly, Vitamin A, may actually be helpful, because Vitamin A contributes to airway cell growth and development.

08:16 All right, now let's wrap up by discussing some ways to treat BPD once it develops.

08:21 Sometimes the symptoms or effects of it can be reduced.

08:25 But remember, no cure exists for BPD.

08:28 Preventing progression of the condition is key.

08:32 First, corticosteroids may be used to help reduce inflammation, However, side effects have to be considered.

08:40 Hydration is always an issue and needs to be monitored closely.

08:44 Infants who are in respiratory distress can sometimes even become dehydrated just because of respiratory distress alone.

08:50 Because the amount of water vapor that is lost through respiratory distress.

08:56 Antibiotics may be given if they have a bacterial infection.

08:59 Because the infant with BPD has a much higher risk of pneumonia due to the fact they have immature lungs at baseline.

09:06 And for the same reasons, these infants should avoid sick contacts and receive all the recommended childhood vaccinations.

09:16 The NCSBN develops the NCLEX exam.

09:20 This model is called the Clinical Judgment Measurement Model.

09:23 The framework and the terms within it are being used in the next generation NCLEX test questions and case studies.

09:30 So let me show you how to make some connections between this model and the content we just covered.

09:36 We're going to emphasize the first two important steps of how to recognize cues, and analyze cues in kids with BPD.

09:44 To recognize cues and an infant who was Risk for BPD, you must know how to properly assess them, their gestational age and their work of breathing.

09:53 Signs and symptoms of respiratory distress are about the same no matter the condition that is causing it.

09:58 Increased work of breathing can include retractions, or sucking in of the skin, anywhere from the substernal area to the supraclavicular area, to nasal flaring to abnormal breath sounds or no breath sounds or reduce breath sounds, tachypnea, cyanosis, other color changes in hypoxia.

10:17 At any time, the infant's body is stressed.

10:19 You can also expect their heart rate to go up.